Review of Wilson N. Jones Medical Center Cardiac Rehabilitation Services

EXECUTIVE SUMMARY:

The objective of this review was to determine whether Medicare properly reimbursed Wilson N. Jones Medical Center (Hospital) for outpatient cardiac rehabilitation services. Even though physician supervision is assumed to be met in an outpatient hospital department, the Hospital did not designate a physician to directly supervise the services provided by its cardiac rehabilitation program. In addition, contrary to current Medicare requirements, we could not identify the physician professional services to which the cardiac rehabilitation services were provided 'incident to.' Further, from our specific claims review of 30 of the 160 Medicare beneficiaries who received outpatient cardiac rehabilitation services during CY 2001, we determined that the Hospital claimed and received Medicare reimbursement for 13 beneficiaries' services, amounting to $4,656, which may not have met Medicare coverage requirements or which were otherwise unallowable. We attributed all of these questionable services to weaknesses in the Hospital's internal controls and oversight procedures.